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ERIC / Constipation and Soiling / Info for Parents /

Info for Parents

Constipation

Constipation is very common in children and for many there is no known reason why it happens (this is known as idiopathic constipation). Recent research has shown that 29% of 4½ year olds and 27.5% of 9½ year olds in the UK suffer with constipation.

A child is considered to be constipated if they poo less than 3 times a week. However every child’s pooing pattern is different and some children will need to poo twice a day whilst others will go only every other day.

Coping with constipation and soiling

constipation family Constipation and soiling can cause children and their families considerable stress. As well as managing the day-to-day problems with constipation and soiling, parents often fear their child may be bullied or ridiculed if they soil outside the home. For some families constipation and soiling can impact on social interaction leading to feelings of isolation for the whole family.

Parents may sometimes feel anger towards their child, mostly due to frustration at not finding a solution to the problem, and lack an understanding of the causes of constipation and soiling. Why can’t he/she use the toilet like other children? Why doesn’t he/she know when they need a poo? Why is he/she happy to poo in their pants and sit in it all day unconcerned? Parents routinely ask questions like these on the ERIC Helpline.

There are no simple answers to these questions as each child is unique and treatment for constipation and soiling, although following common guidelines, must be tailored to meet each child’s individual need.

In 2009 100,000 children in the UK were treated by their GPs for constipation and soiling problems. For most children, constipation can be successfully resolved. It can be a long journey, needing ongoing support from health professionals and much patience and encouragement from parents and carers. The quicker a child has an assessment by their GP, the easier it will be to manage and resolve the problem.

Causes of constipation

Withholding poo (avoiding going to the toilet)
Fear of the toilet (sometimes associated with pain or discomfort)
Lack of a toilet routine (some children have such busy lives that it can be difficult to find time to sit and relax on the toilet each day)
Resistance to toilet training and an insistence that a nappy be put on to poo in
A diet that is not fully balanced
Low fluid intake
A change in routine
Anxiety and emotional upset
Some medications may cause constipation
Illness

Download our fact-sheet about what can cause constipation and problems with pooing

Recognising the signs

Pooing less than three times a week
Regular and foul smelling wind
Foul smelling poo
Painful tummy
Distended tummy
Poo looks like hard pellets
Pain when pooing
Straining
Withholding poo
Poor appetite
Lack of energy
Unhappy, angry or irritable mood
Soiling

The Bristol Stool Form Scale can help you identify whether poo is becoming constipated. The ideal poo is number 4 on the scale - a soft, smooth sausage shape. You can download the Bristol Stool Form Scale here

Establishing a routine

constipation girl writing The pace of life can be so busy that it is easy to neglect the need to ensure there is time in the day for children to have a relaxed sit on the toilet for a poo.

Putting a toilet routine in place will ensure that sitting on the toilet for a poo is a regular part of a child’s day and will encourage the complete emptying of the bowel on a regular basis, helping to lessen pooing accidents and avoid constipation.

A toilet routine is especially important for boys who, once they begin to stand up to wee, have to make a special effort to sit on the toilet for a poo and pooing can become rushed or simply forgotten.

Tips for successful pooing on the toilet

The correct way to sit on the toilet to have a poo

Tips on what to do when a child prefers to poo in a nappy

Older children

constipation girl writing Approximately 1% of young people over the age of 12 have constipation and soiling difficulties. It may be that the problem has existed from an early age without being resolved, or it may just suddenly start. It is not unusual for older children to deny there is a soiling problem or to hide underwear. The problem is not associated with laziness so it is helpful to remain positive and calm and ensure they visit their GP for an assessment and treatment to resolve the problem.

Managing soiling in school can be helped by carrying a changing kit with underwear, wipes and sealable bags in the school bag. The school nurse or head of pastoral care can often support the young person in a confidential way.

Download our fact-sheet to find out what parents can do to help resolve constipation

Soiling

What is soiling?

constipaiton boy bubbles Children soil when they poo in their pants, on the floor or in other inappropriate places. Some children have a more regular and persistent difficulty.

Soiling is usually a symptom of constipation and requires treatment to remove the hardened poo in the bowel and to keep the bowel clear.

Some younger children may have poo in their pants and appear to soil because they are still learning to recognise when they need to poo, or can’t yet wipe themselves properly.

Why soiling happens

Constipation is the most common cause of soiling. When children don’t poo regularly, the bowel can become loaded with large poos that are hard to pass. This is sometimes called faecal impaction.

Poo can appear runny (like diarrhoea), in small lumps or can be visible around the bottom and difficult to wipe away. Soiling occurs when runny poo leaks around the hard lump that is blocking the way; or if there has been a longstanding problem of constipation the lower bowel and rectum may have become overstretched. Soiling can happen several times a day as the child does not always receive the message that they need a poo or is not always aware that the poo has come out.

Treatment for constipation and soiling

Most parents seek help initially from their health visitor, school nurse or GP. Keeping a record of how often pants are soiled, poo is passed in the toilet and the type of poo passed will help health professionals assess the problem and offer appropriate intervention.

Treatment is likely to include:

Medication to relieve constipation and clear faecal impaction (this is likely to be Movicol but could be a stool softener, stimulant laxative or bulking agent). The medicine is then continued to ensure that the poo remains regular and easy to pass, stopping the medication too soon can result in the constipation building up again
Suggestions for appropriate changes to the diet and fluid intake
Establishing a regular routine of sitting on the toilet for a few minutes at least once a day, 15-20 minutes after a meal
Checking that your child is positioned comfortably and securely on the toilet (using a child seat if necessary), and ensuring that feet are firmly on the floor or supported on a step will help your child push poo out
Teaching your child the technique of gently rocking forwards and back when sitting on the toilet
Motivating your child by involving them and offering simple rewards for achieving targets
Occasionally psychological help is useful to explore anxieties or stress that may be associated with, or aggravating the problem

Download our fact sheet about anal irrigation systems

Always consult your GP if your child is showing signs of constipation or there are changes in bowel patterns.

If the constipation and soiling problem is persistent or complex, referral to a paediatric continence advisor, paediatrician, paediatric gastroenterologist or the involvement of a child psychologist might be helpful.